Hair loss restoration

☎ +7 (921) 886-56-64, +7 (812) 291-39-29, +7 (901) 304-44-00

Free online consultation

Please fill out the form below to receive free detailed recommendations from our doctors. Fields with * are required.

* Your name:

Your city and country:

* E-mail:

Phone:

* Age:

* Sex:

Hair color:

Your hair:

Structure of hair:

Please select an image matching your wet hair the most:

grade I

grade II

grade III

At what age you first encountered a hair loss problem?

Did you experience more severe hair loss in the recent 5 years?

Yes No

Do you have chronically thinning hair in the front hair line zone?

Yes No

Do you have chronically thinning hair in the back zone of your head?

Yes No

Do you experience hair loss at the top of your head?

Yes No

Is your scalp visible through the dry hair?

Yes No

Is your scalp visible through the wet hair?

Yes No

Is your hair thinner on the top of your head than at the sides or in the back of the head?

Yes No

Have you ever noticed that you need your hair at the sides and in the back of your head cut more often than hair on the top of the head?

Yes No

In which area of your head do you experience the most severe hair loss?

Did you consult a hair restoration specialist ever before?

Yes No

Have you taken medicines for hair loss (if yes, please specify)?

Have you undergone a hair restoration surgery?

Yes No

Do you consider a hair restoration surgery to be a possible solution for your hair loss problem?

Yes No

Have you taken previously or are taking currently the following medicines?

Rogaine:

previously

currently

Propecia:

previously

currently

Please attach an image file or image files of the area of your head with a hair loss problem:

Photo #1

Photo #2

Photo #3

Example: